Provider Demographics
NPI:1265696983
Name:KIM, RICHARD K (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1307 DOLLEY MADISON BLVD STE 3C
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3913
Mailing Address - Country:US
Mailing Address - Phone:703-336-2406
Mailing Address - Fax:703-646-7584
Practice Address - Street 1:1307 DOLLEY MADISON BLVD STE 3C
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3913
Practice Address - Country:US
Practice Address - Phone:703-336-2406
Practice Address - Fax:703-646-7584
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2023-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL1250487992084P0800X
VA01012442212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry